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International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064

Index Copernicus Value (2013): 6.14 | Impact Factor (2015): 6.391

Volume 5 Issue 6, June 2016

www.ijsr.net Licensed Under Creative Commons Attribution CC BY

Masticatory Efficiency of Complete Dentures

Constructed by different Denture Base Materials

Abd El Aziz O1, Saba E.K.A

2, Mesallati S.A

3.

1Professor of Prosthodontic, Alexandria University Faculty of Dentistry, Alexandria, Egypt

2Lecturer of Physical medicine, Rheumatology and Rehabiliatation, Alexandria University Faculty of Medicine, Alexandria, Egypt

3BDS, Faculty of Dentistry, Benghazi University, MS, Alexandria University, Egypt

Abstract: Introduction: one of the primary function of the complete denture is to restore masticatory function in the people who have lost their

natural teeth, studies have reported that the values for maximum biting force in patient wearing complete dentures were only one-fifth to one-

sixth the values reached by dentate subjects however, problems such as discomfort and difficulty in chewing certain foods are generally reported

by its wearers as a result of a reduced masticatory efficiency, which ranges from 16% to 50%, when compared to dentate subjects the question

arises-do the primary stress-bearing areas actually dissipate the functional forces, or are these forces conveyed elsewhere by the intervening non

rigid acrylic base material?.The electromyography has been observed in various investigations that there is a linear relationship between direct

force measurement and electromyography activity potential. The aim of the study: The study aims to clinically evaluate the masticatory

efficiency of the flexible complete denture and the conventional complete denture. Martials and methods: for the purpose of the study 7 male

completely edentulous patients between the ages 45-55 years selected. For each patient two set of complete dentures was fabricated, the First one

is flexible denture and the second one is conventional acrylic denture. Surface electrodes from electromyography unit were placed in the region

of right and left anterior temporalisand masseter muscles and electromyography activity was recorded. Quantitative parameters were assessed.

Quantitative parameter is bite force by electromyography evaluation which was measured after insertion. Result and discussion: Qualitative

data were described using number and percent. Quantitative data were described using range (minimum and maximum), mean, standard

deviation and median. Significance of the obtained results was judged at the 5% level. Conclusion; The EMG activity of the masseter muscle

higher in flexible denture base than conventional acrylic denture base during clenching on preformed silicon index, and when chewing soft and

hard food after two months. The anterior temporalis muscle showed higher activity in flexible denture base than conventional acrylic denture

base during clenching on preformed silicon index, when chewing soft food and hard food.

Keywords: acrylic denture base, flexible denture base, masticatory activity, electromyography

1. Introduction

The loss of natural teeth not only results in aesthetic issues

to individuals, but can also seriously risk masticatory

function. Long-term dentation could eventually result in

bone resorption, temporomandibular disorders or muscle

hypo- tonicity which ultimately leads to direct damage to

the masticatory process.[1]

Furthermore, a reduction in the physiological secretion of gastric

acid is characteristic of the aging human process which

reinforces the importance of efficient mastication to start food

digestion processes. [2]

One of the primary function of the complete denture is to

restore masticatory function in the people who have lost their

natural teeth, studies have reported that the values for

maximum biting force in patient wearing complete dentures

were only one-fifth to one- sixth the values reached by dentate

subjects.[3]

However, problems such as discomfort and difficulty in

chewing certain foods are generally reported by its wearers

as a result of a reduced masticatory efficiency, which ranges

from 16% to 50%, when compared to dentate subjects.[4]

Their chewing, admittedly limited, may predispose these

individuals to a variety of problems, such as; inability to

chew tough or hard foods, - oral pain, instability of their

complete dentures.

Chewing efficiency is reduced when teeth are replaced by

complete denture.[5] The bite force measurements can be

recorded directly by using a suitable transducer which is a

convenient way of assessing the maximum voluntary bite

force. Another method to record bite force is indirect

evaluation by means of electromyography. It has been

observed in various investigations that there is a linear

relationship between direct force measurement and

electromyography activity potential. [6]Electromyography

techniques have permitted more precise assessment of the

muscle functions than that was previously possible by

clinical observation. [7]

The measurement of bite force can provide useful data for

the evaluation of jaw muscle function and activity. It is also

an adjunctive value in assessing the performance of

dentures.

Technological advances in signal detection and processing have

improved the quality of the informationextracted from bite force

measurements. [8]

The main goal of this study is to evaluate the masticatory

efficiency of flexible complete denture base in comparison

with heat cured acrylic dentures.

Paper ID: NOV164376 http://dx.doi.org/10.21275/v5i6.NOV164376 1292





2. Material and Method

Patient selection Seven patients were selected from the department of

removable prosthodontics, faculty of dentistry, Alexandria

University, having maxillary and mandible edentulous

ridges.

For each patient two set of complete dentures were

fabricated, the First one is flexible denture and the second

one is conventional acrylic denture.

Patient selective criteria

Inclusive criteria

Malepatient's age ranging from 45-55 years.

Free from any systemic or neuromuscular disorder that

might affect chewing efficiency of masticatory muscles.

Free from any tempro-mandibular joint disorder,

xerostomia/excessive salivation and abnormal tongue size.

Class I Angle’- ridge relationship.

Exclusive criteria

1. Patient with abnormal tongue behavior and/or size

2. Patient with xerostomia or excessive salivation

3. Patients with habits like bruxism, habitual eccentric

movements etc. which would compromise the results.

Method

Steps of construction were made for upper and lower ridges;

1. Preliminary alginate impressions (Cavex impressiona in a

stock tray).

2. The impressions were poured with dental plaster to form

study casts upon which custom made trays were

fabricated in auto-polymerized acrylic resin.

3. Final impression for upper and lower ridges was made

by using zinc-oxide (Cavex outline).

4. The impressions were poured using dental stone to obtain

the master casts and record blocks consisting of auto

polymerized acrylic resin record base and wax occlusion

rims were fabricated.

5. Registrations of maxilla-mandibular relations were

carried out.

The relation of the maxillary record blocks to the T.M.J was

recorded with the face bow and transferred to the semi-

adjustable articulator.

6. The mandibular record blocks were mounted using

interocclusal centric record following the standard

procedure.

7. (Acrylic cross-linked, Acrostone , Egypt) teeth were

selected, Try-in made and the occlusion carefully

checked on the articulator as well as in the patient.

Dentures processed by 2 techniques according to type of

denture base material:

Flexible complete dentures processed by injection cast

technique.[9]

Conventional acrylic complete dentures.Processed in a

water bath curing tank for 1½ hour at 74°c and another 1

hour at 100°c. Then, the dental flask was cooled to room

temperature.

Denture laboratory remounted, finished and polished then,

the finished dentures checked for proper extension, retention

and stability intra-orally. The patient given a proper

program for denture insertion and oral hygiene measures.

(Fig. 1 & 2)

Figure (1): Finished flexible denture

A: Extraoral, B: Intraoral.

Figure (2): Finished conventional acrylic denture

A: Extraoral, B: Intraoral.

Patients was instructed to follow general instructions as they

were following for their normal acrylic denture.

The patient was recalled after 48 hours to check for any

pressure area causing pain or discomfort.

Electromyography evaluation.[10]

Evaluation of masticatory function was performed by

measuring muscle activity of the masseter and anterior

fibers of the temporalis muscle on both sides for both

dentures at the end of the two weeks using

electromyography with three types of test foods.[11]

EMG recordings were made after the completely absence of

any discomfort, when the patients were presumed to be

adapted to their dentures, after one month then two months

later.

During all recording, the patients were seated with their

head unsupported and were asked to maintain a naturally

erect position.

The massetric myoelectric activities of both sides (left and

right) were recorded by means of bipolar electrode

positioned on the bellies of the muscles parallel to the fiber

orientation.

The recording electrodes were approximately 20 mm apart.

The patient was grounded by grounding electrode by fixing

the third electrode on the palm of the patient hand.

Electro-conductive gel was used on the electrode before

contacting the skin.






Figure 3: Bipolar electrodes positioned at A: masseter

muscle B: Anterior temporalis muscle.

Each patient was instructed to clench on standardized size of

preformed silicone index (13x13x13mm) made by vinyl

polysiloxane material(putty) positioned at premolar region

for 30 seconds to measure the muscle activity during

clenching.

Then the patient was instructed to chew on standardized size

of hard food (raw fresh carrot) (13x13x13mm) for ten

seconds intervals then the EMG were recorded.

Then the patient was instructed to chew on standardized size

of soft food (banana) (13x13x13mm) for ten seconds

intervals then the EMG were recorded.

The patient chewed the test samples on the right and left

sides at ten seconds to swallow before the EMG was

recorded.

At the end of the record and before removing the surface

electrodes, the positions of the electrodes were marked to be

used as a guide for accurate reproducibility.

The previous tasks were separated by a recovery rest period

of 2 minutes.

The same procedure was repeated with the anterior

temporalis muscle on both sides (right and left).

3. Results Seven patients were selected from the department of

removable prosthodontics, faculty of dentistry, Alexandria

University, having maxillary and mandible edentulous

ridges.

For each patient two set of complete dentures

werefabricated, the First one is flexible denture and the

second one is conventional acrylic denture.

Seven completely edentulous patients were selected for this

study where all the patients received two complete dentures

the first one is flexible denture and the second one is

conventional acrylic denture.

After using the denture for period of one week with each

denture, masticatory function was evaluated by recording

the EMG activity for masseter and anterior temporalis

muscles during clenching on preformed silicon index,

chewing banana and chewing carrot as test foods,one month

and two months later.

Data was collected, tabulated and statistically presented as

follows;

Table (1); comparison between conventional acrylic denture

and flexible denture according to EMG signals (mean

values) of masseter muscle during clenching on preformed

silicon index after one week, one month, and two months

later.

The table shows statistical significant difference between

the conventional acrylic denture and flexible denture during

clenching with preformed silicon index only after one week

(p=0,011), no statistical significant difference between the

conventional acrylic denture and flexible denture after one

month and two months later.

Table 1: Comparison between the two studied groups.

Clench ` Fc2 P

1 weak 1 month 2 months

Conventional (n=14)

Min. – Max. 97.0 – 480.0 0.53 – 442.0 147.0 – 308.0

6.143* 0.046* Mean ± SD. 351.29 ± 133.63 258.09 ± 128.78 243.14 ± 49.21

Median 400.50 272.50 242.0

Sig. bet. Periods p1= 0.074,p2= 0.052,p3= 0.433

B- flixable (n=14)

Min. – Max. 0.47 – 440.0 172.0 – 453.0 251.0 – 593.0

8.143* 0.017* Mean ± SD. 184.82 ± 116.33 265.29 ± 80.77 377.57 ± 124.39

Median 160.50 247.50 309.0

Sig. bet. Periods p1= 0.022*,p2= 0.009*,p3= 0.048*

Z 2.528* 0.528 3.240*

P 0.011* 0.597 0.001*



values) of masseter muscle during chewing soft food after

one week, one month, and two months later.



chewing soft food only after two months (p=0,011), no

statistical significant difference between the conventional

acrylic denture and flexible denture after one week

(p=0,232) and one months (0,597).







Soft Masseter after Fc2 P


Conventional (n=14)

Min. – Max. 77.0 – 633.0 0.53 – 442.0 147.0 – 308.0

1.857 0.395 Mean ± SD. 307.71 ± 185.80 258.09 ± 128.78 243.14 ± 49.21

Median 276.0 272.50 242.0


B- flixable (n=14)

Min. – Max. 56.70 – 401.0 172.0 – 453.0 251.0 – 593.0

6.143* 0.046* Mean ± SD. 224.19 ± 97.49 265.29 ± 80.77 377.57 ± 124.39

Median 193.0 247.50 309.0

Sig. bet. Periods p1= 0.221,p2= 0.013*,p3= 0.048*

Z 1.195 0.528 3.240*

P 0.232 0.597 0.001*



values) of masseter muscle during chewing hard food after




chewing hard food only after two months (p=0,026), no


acrylic denture and flexible denture after one week

(p=0,232) and one months (0,251).

Table 3: Comparison between the two studied groups

Hard Masseter after Fc2 P


Conventional (n=14)

Min. – Max. 66.70 – 437.0 0.71 – 698.0 177.0 – 401.0

1.857 0.395 Mean ± SD. 313.12 ± 109.28 383.86 ± 224.46 292.57 ± 56.94

Median 327.50 380.0 303.50


B- flixable (n=14)

Min. – Max. 0.20 – 520.0 222.0 – 757.0 210.0 – 621.0

5.571 0.062 Mean ± SD. 249.01 ± 168.67 341.79 ± 153.60 388.14 ± 128.19

Median 210.0 293.60 355.0

Sig. bet. Periods p1= 0.272,p2= 0.030*,p3= 0.221

Z 1.195 1.149 2.229*

P 0.232 0.251 0.026*



values) of anteriortemporalis muscle during clenching on

preformed silicon index

The table shows no statistical significant difference of the

anterior temporalis muscle between the conventional acrylic

denture and flexible denture during clenching on preformed

silicon index.


Clench Temporalis after F P


Conventional (n=14)

Min. – Max. 0.65 – 420.0 0.47 – 232.0 145.0 – 411.0

4.000 0.135 Mean ± SD. 144.73±119.89 164.53±73.91 228.57±73.24

Median 159.50 198.50 200.0

Sig. bet. Periods p1=0.331,p2= 0.041*,p3= 0.433

B- flixable (n=14)

Min. – Max. 0.61 – 393.0 99.0 – 497.0 107.0 – 578.0

15.429* <0.001*/ Mean ± SD. 131.61±114.96 216.21±103.91 303.07±151.67

Median 135.0 210.50 250.50

Sig. bet. Periods p1= 0.008*,p2= 0.004*,p3= 0.286

Z 0.781 1.356 1.425

P 0.435 0.175 0.154



values) of anterior temporalis muscle during chewing soft

food after one week, one month, and two months later.



chewing soft food only after two months (p=0,009), no







acrylic denture and flexible denture after one week (p=0,783) and one months (0,783)


Soft Temporalis after F P


Conventional (n=14)

Min. – Max. 0.59 – 380.0 0.53 – 307.0 92.10 – 360.0

6.143* 0.046* Mean ± SD. 152.49 ± 122.48 205.52 ± 93.51 216.08 ± 70.25

Median 188.50 224.50 211.50

Sig. bet. Periods p1= 0.245,p2= 0.041*,p3= 0.245

B- flixable (n=14)

Min. – Max. 0.33 – 397.0 105.0 – 437.0 187.0 – 757.0

9.418* 0.009* Mean ± SD. 143.56 ± 130.64 232.0 ± 99.53 359.71 ± 175.93

Median 152.0 213.0 300.50


Z 0.276 0.276 2.620*

P 0.783 0.783 0.009*



values) of temporalis muscle during chewing hard food after


The table shows no statistical significant difference of the

anterior temporalis between the conventional acrylic denture

and flexible denture during chewing hard food after one

week (p=0,550), one month (p=0,765), two months

(p=0,060).

Table 6: Comparison between the two studied groups

Hard Temporalis after F P


Conventional (n=14)

Min. – Max. 0.48 – 477.0 0.53 – 543.0 65.0 – 440.0

2.286 0.319 Mean ± SD. 192.44 ± 163.87 286.31 ± 144.54 248.87 ± 100.34

Median 210.0 304.50 247.0


B- flixable (n=14)

Min. – Max. 0.51 – 720.0 80.0 – 687.0 221.0 – 614.0

10.857* 0.004* Mean ± SD. 181.77 ± 216.37 308.50 ± 176.70 344.29 ± 127.92

Median 120.50 253.0 303.0


Z 0.597 0.229 1.884

P 0.550 0.765 0.060

F2: Chi square for Friedman test for comparing between the

different periods

Z: Z for Mann Whitney test for comparing between the two

groups

Sig. bet. periods was done using Wilcoxon signed ranks test

p1: p value for comparing between 1 weak and 1 month

p2: p value for comparing between 1 weak and 2 months

p3: p value for comparing between 1 month and 2 months

*: Statistically significant at p ≤ 0.05

4. Discussion

Masticatory function is generated by rhythmic contraction

of masticatory system. Several other parameters are

important, such as number of teeth and quality of occlusal

contacts and health of the masticatory system. [12]

Masticatory forces in completely edentulous mouth directly

depends on the size of muscles creating the forces, their

position in the mandible, type of chewing , shape of the

edentulous alveolar ridge and the degree of intermaxillary

separation.

Bite force in complete denture wearers are significantly

decreased in relation to people with natural teeth. There is a

fundamental difference in the distribution of the functional

energy in complete denture wearers and subjects with intact

teeth. Reduction of masticatory efficiency in denture

wearers may be caused by irregular flow of energy during

mastication. [13]

In this study, seven completely edentulous Patients were

selected with their age ranging from 45 to 55 (mean age of

50 years) to avoid muscle changes due to senility. There is

variation in muscle efficiency due to age, as the patients in

the same age group show almost the same muscle

efficiency. [14]

Masticatory performances decrease with age as other motion

activities. Muscle fatigue accompanied by bite force

diminution and tongue-motor decline are often found in

elderly persons. These changes that occur during healthy

aging depress the masticatory ability and may provoke

swallowing difficulties. [15]

The selected patients were male to avoid the difference in

muscle efficiency between different sexes. [16] There are a

variety of factors may contribute to preference of male

selection [17], including hormonal alternations [18], blood

pressure [19] and psychological factors. [20]






Furthermore, elderly females showed a lower rate of

chewing efficiency than males. [21]

Patients with systemic disease or neuromuscular disorders

were excluded to avoid any effect on the muscle tone and

hence resultant masticatory efficiency. [22]

Patients with tempro-mandibular joint dysfunction were also

excluded to avoid any disturbance in muscle behavior. [23]

Moreover; patients with abnormal ridge relationship were

avoided because dentate subjects with normal occlusion

were found to have a better masticatory efficiency than

subjects with malocclusions. [24]

The abnormal tongue behavior or size and/or xerostomia or

excessive salivation were exclusive factors during the

patients selection, as that may affect the dentures stability,

retention and subsequent the patient’s satisfaction

rating.[25]

Incorporation of accurate centric relation was important not

only for mounting lower cast but also to avoid

jeopardization of retention, stability and interference with

mastication. [26, 27] Ideally, to establish bilateral balanced

occlusal scheme, fully adjustable articulator should be used.

However; it is not always available. Hanau model semi-

adjustable articulator was used.

Acrostone cross- linked acrylic teeth were used in this study

to standardize the type of teeth used in all the constructed

dentures in this study. Cross-linking improves strength and

wear resistance which enhances the ability of acrylic teeth to

maintain a stable occlusal relationship [28] that produce

better chewing and masticatory performance.

Maxillary and mandibular removable flexible complete

denture wears fabricated (acrylfast) for each patient using

injection cast technique.

Flexible denture used in this study was reported no denture

sore-mouth and the better comfort level, better retention and

stability in flexible dentures due to low modulus elasticity of

this material. [29]

Maxillary and mandibular removable acrylic complete

denture wear fabricated for each patient using the

standardized conventional technique.

Finished dentures were tried in the patient’s mouth at the

time of delivery to check for any occlusal discrepancies and

border extensions that could impair denture stability as well

as retention that might affect masticatory efficiency during

the initial learning period after denture insertion.

Same patients received both types of denture alternatively to

avoid bias resulting from individual variation. [30]

Electromyography (EMG) has also been used to assess the

masticatory function of conventional and flexible complete

removable denture.

-The masseter and anterior temporalis muscles on both sides

were evaluated because they are the largest and strongest of

the masticatory muscles, the most superficial and are

accessible to surface EMG examination.

The surface EMG recording provided as safe, easy and

noninvasive method that allowed objective quantification of

the energy of the muscle. [31]

The objective evaluation of masticatory efficiency was

made during chewing different types of food, either hard

and soft (carrot and banana. [32]

Carrot and banana were chosen as test food material,

because of their reliable natural test and their suitability for

complete denture wearers who could easily crush and

comminute those. [33]

Moreover, both carrot and banana were cut into small and

symmetrical pieces of about 13 mm to eliminate the

influence of different food size on muscular efficiency. [34]

Standardized measure of preformed silicon index 13mm was

used to measure the muscle activity during clenching.

To ensure muscle relaxation during EMG recording, the

patients were seated in an upright position to avoid the

postural effect on the recorded muscle activities. The site of

electrode placement was rubbed with abrasive gel and

cleansed with a cotton pellet moisten with alcohol before

electrode placement to remove excess oil that reduces skin

electrical resistance. This enhanced contact with the

electrodes to obtain signals of good quality. An electro

conductive gel was used to improve conductivity[35].

For this study, the disposable bipolar electrodes were

positioned on the bellies of the muscles parallel to the fiber

orientation because higher electrical activity was recorded

from electrode pairs parallel to the muscle fibers. The

interelectrode distance used was fixed at 20 mm to avoid

variability in the results. When bipolar electrodes are being

applied on relatively small muscles the interlectrode

distance should not exceed 1/4 of muscle fiber length. In

this way unstable recordings, due to tendon and motor end-

plate effects can be avoided. [36]

The end of the record and before removing the surface

electrodes, the positions of electrodes were marked to be

used as a guide for accurate reproducibility.[36]

Also the patients participated in this study were evaluated at

different follow up period. Each denture was evaluated

within one week, one month and two months periods. Those

were thought to be sufficient periods of time forevaluation

as confirmed by Hein AT, 2013. [37]

The results of this study showed a significant for

masticatory function by EMG between studied acrylic and

flexible denture base with higher mean scores of EMG

activity for the flexible denture for masseter muscle during

clenching on preformed silicon index, when chewing soft

and hard food after two months. .this result agrees with

Wostmann et al. who conclude that the flexible dentures

much more comfortable for the patient.[38]






This result agree with Karakazis HC and Kossion AE who

reported that the Chewing efficiency showed marked

increased by time infavor to the conventional acrylic

because improving denture adaptation which may be due to

the neuromuscular control which is gradually and slowly

generated by time, i.e. the longer the period of denture

wearing, the better the neuromuscular control gained. [31]

The result of this study showed that the EMG activity of the

masseter and anterior temporalis muscles during chewing

hard food higher than chewing soft food. This finding is also

agree with van der Bilt et al, [39] who stated that harder

food consistency required higher muscle activity levels due

to higher muscle force needed to comminute hard food.

The mean EMG activity increased by the time in both

conventional acrylic denture base and flexible denture base

either in masseter and anterior temporalis muscles. this

result agree with Karakazis HC and Kossion AE who

reported that the Chewing efficiency showed marked

increased by time infavor to the conventional acrylic

because improving denture adaptation which may be due to

the neuromuscular control which is gradually and slowly

generated by time, i.e. the longer the period of denture

wearing, the better the neuromuscular control gained. [33]

5. Conclusion

Within the limitations of this study of short follow up

periods of conventional acrylic complete denture and

flexible complete denture, the results lead to the following

conclusions;

EMG activity of the masseter muscle higher when

clenching on preformed silicon index in conventional

acrylic denture base.

EMG activity of the anterior temporalis muscle higher

when chewing soft food in conventional acrylic denture

base.

In flexible denture base the EMG activity of the masseter

and anterior temporalis muscles high during clenching on

preformed silicon index, and when chewing soft and hard

food.

The EMG activity of the masseter muscle higher in

flexible denture base than conventional acrylic denture

base during clenching on preformed silicon index, and

when chewing soft and hard food after two months.

Flexible denture base higher EMG activity of the

temporalis muscle when chewing soft food.

Greater muscle activity of the masseter and anterior

temporalis when chewing hard food

The masseter muscle shows higher muscle activity

compared to anterior temporalis muscle.

The anterior temporalis muscle showed higher in activity

in flexible denture base thanconventional acrylic denture

base during clenching on preformed silicon index ,when

chewing soft food and hard food.

Chewing efficiency showed marked increased by time

infavor to the conventional acrylic denture base and

flexible denture base.

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Author Profile Souad A. Mussa Mesallati, received the B.D.S. in Dental and

Oral Surgery from Benghazi University, Faculty of Dentistry 2008.

During 2008-2009, she practiced in Ministry of Health. Since

2009-2012, she worked as a demonstrator in Benghazi University.

During 2012 till now, she educated for M.S degree in

prosthodontics in prosthetic department, Faculty of dentistry.

Alexandria University.


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